Let's get real about commissioning

The main problem is, the people 'high up' in the multiples who go hell for leather to provide a service are NOT the people who have to go to the training courses, usually in their own time, and actually PROVIDE the service. Look at the recent example of Mimi Lau saying, "oh yes, pharmacists can do the flu jabs in children" OK, fine, but can I have the staff and resources to do it? Can I be paid for the training day, that last year was held on a Sunday? Can I get a percentage of the fee from every jab I do?
The multiples and other pharmacies must look at their staffing levels and skill mix before they apply to provide services.
Two chains I work for have signed up for the HLP scheme (Healthy living pharmacy) Now one of them has decided some shops are over-staffed and is reducing staff hours by 20-30 a week. This often leaves just a pharmacist, a dispenser and maybe one assistant on an afternoon. The other has decided that locums and employed pharmacist may need to take a pay cut due to category M cuts. This is after signing them up to do A LOT more work!!!
This is the reason why the quality suffers. If you are a pharmacist in the consulting room doing EHC or MURs or smoking cessation, you are VERY aware of time and who and what may be waiting upon completion of the service. This can lead to rushing or skipping things and may leave the client and pharmacist unsatisfied with the outcome. It also dents the pharmacists morale and enthusiasm for service provision. We still have to do the prescriptions AND everything else involved in running a pharmacy today.
Interestingly, in a PCT local to me, of the 70 pharmacies, barely any independents signed up to the HLP scheme. Is this because Mr or Mrs Independent is much more mindful and aware of the pressure that will be placed on them?
I read a comment from one PCT person, saying he was fed up of independents, and when designing a new service went to the multiples. This is a perfect example of how he will meet with probably 90% of people/pharmacists/area managers who will NOT actually be in front of the patient providing the service!

It's time to deliver - use it or you lose it!

We know the direction of travel is for lower dispensing item value, so it's important to look at other opportunities. We need to deliver on services such as minor ailments, EHC and smoking cessation and we need to be more aware of the key issues of Public Health and managing long term conditions.

You can harp back to the "good old days" - how many would want to make (or even know) SCC sal cap or icthammol in lassars paste?

Setting realistic goals from the beginning is the most important thing. The number of MURs needed to recover the otherwise lost remuneration was set far too high and the consequence is that people mislead patients into the reason for them to persuade then to participate and conduct totally unnecessary ones just to make up the numbers. The same applies to the New Medicines Service. The trouble is that our "negotiators" (PSNC) are out of touch with practice and appear to be powerless against the DOH in any case.

Very true Paul.The Mur fees sould be reduced to £3-5 per Mur and should only be paid on production of proof that that some change in medication is applicable and the doctors has affected the change in prescription.This will reduce the pressure on pharmacists all across the board.

When pharmacy contractors give away services and pct's continue fund the services they want on locum pharmacist rates are you really suprised that commissioners must be rubbing their hands with glee at the prospect of not paying the market rate for anything pharmaceutical. You really have despair at he the levels of ignorance shown by contractors of all variations about how much it actually costs to provide the services they have signed upto, and even worst cannot fill out simple forms or track their payments. The maxim of if he is doing it down the road then I have to do it as I will lose all my patients rules. If pharmacy is truely to take its place at the healthcare table then it has to be very selective at choosing the services that they provide and drop services that do not pay., and stop when the contract ends.
BHARAT KOTECHA, Locum pharmacist is typical of a proposal that is not thought through. MUR's are for the benefit of PATIENTS not GP's, how may MURs would have to be performed (without payment) to get the MUR that effects a prescription change?
As I said before I cannot wait for when the management consultants of ilk of KMPG, are used to commission services and enforce contracts or SLAs then pharmacy contractors will be very sorry they have not taken a business attitude to service provision
PS what is community pharmacy contractor's time worth?